Authors and affiliations

Kevin O. Amaniampong1,2, Jennifer C. Park1,2 and Joy M. Richman1,2 Faculty of Dentistry, University of British Columbia1 , British Columbia Children’s Hospital2,

Vancouver, Canada

Objectives

The Covid-19 pandemic resulted in a drastic change in dental care across the globe, particularly in the area of virtual consultations or teledentistry. Our primary objective was to determine if differences exist between the estimated and actual numbers of teeth requiring treatment and the time required under general anesthesia for treatment in virtual and in-person dental consultations. Secondarily, we assessed the distance from the primary residence to BC Children’s Hospital (BCCH) for families who used virtual consults and in-person consultations.

Methods:

A retrospective chart review was conducted on patients aged 1.3 -18.7 years who underwent fullmouth dental rehabilitation under general anesthesia at BCCH. Charts were gathered for July 2020, November 2020, March 2021, and June 2021. Data were collected for both types of consultations and included patient demographics, estimated treatment information (predicted treatment time, number of teeth planned for treatment), presence of caregiver-obtained pretreatment photographs, and actual treatment outcomes. The average percent difference was calculated by determining the difference between predicted and actual values and expressing this difference as a percentage of the predicted value. One-way ANOVA with Tukey’s post hoc testing and unpaired T-tests were performed using Prism V10.0. Human ethics # H21-02433.

Results:

A total of 321 patients [Mean Age = 76.277± 49.4 months] were included. There were 183 (57%) in-person and 138 (43%) virtual consultations. Out of the virtual consultations, 97 (70%) included pretreatment photographs, while 41 (30%) did not include pretreatment photographs. The average difference in the predicted versus the actual time needed for treatment was significantly higher in virtual consultations without pretreatment photographs (31.2%) compared to both in-person consultations (22.3%, p-value = 0.007) and virtual consultations with pretreatment photographs (21.9%, p = 0.01; Figure 1). No significant differences were found in the percentage difference in teeth treated between the conditions. Significant differences (p = 0.003) were observed between the average distance traveled to the hospital between all virtual (138km) and in-person (60.8km) patient consultations. 

Conclusions:

Our findings suggest that virtual dental consultations can be effective for planning dental treatment under general anesthesia, especially for families who live farther away. Our study highlights the importance of photographs in treatment planning for VH patients. Our study may lead to the more widespread adoption of virtual consultations for a variety of dental treatments.

Mayhay Ho, Jennifer C. Park and Joy M. Richman

Faculty of Dentistry, University of British Columbia and British Columbia Children’s Hospital, Vancouver, Canada

Objectives:

The COVID-19 pandemic imposed clinic closures at the B.C. Children’s Hospital (BCCH) and greatly reduced capacity due to public health guidelines. The Dental Department implemented virtual health (VH) consultations for children who were referred for full mouth dental rehabilitation under general anaesthesia (GA). The objectives of this study are:

1. To determine the satisfaction and perception of primary caregivers with VH vs. in-person (IP) dental consultations

2. To evaluate whether improvements can be made to the current VH visit format

3. To determine whether families would like VH consultations to continue post-pandemic

Methods:

Participants were primary caregivers of children (1-17-years) who attended an IP or VH consultation at BCCH from January 2021 to July 2023. Caregivers were excluded if they attended both IP and VH consultations within 1 year, attended a VH consultation by telephone only, or if they did not consent to be contacted by email.

Participants were emailed the link to the BCCH QI/QA REDCap site. The anonymous survey contained questions about demographics, caregiver satisfaction and perceptions. Participants in the VH group also completed a standardized telehealth usability questionnaire (TUQ; Fung et al., 2020). In addition, caregivers who attended IP consultations were invited to complete the survey in person.

Results:

A total of 238 caregivers completed the survey of which 185 were complete (response rate of 22.0%).

VH families (N=45) are mostly from rural settings compared to IP families (N=140). IP caregivers ‘completely’ agreed with the 10 satisfaction statements 70.5-85.3% of the time similar to VH caregivers (66.7-84.6% of the time). The average TUQ score (scale 1-4) was 3.55. Once a family had used VH, they were very likely to use this format again (89.8% would use VH services again, vs. 24.8% in the IP group). The most common benefits in the VH group were time savings, ease of scheduling, and cost savings whereas the most common barrier was difficulty taking intraoral photos. The benefits felt by the IP group were meeting the dental team and ease of communication with the dental clinic whereas the most common barriers were parking and behavioural challenges of their child during the consultation.

Conclusions:

The format of both IP and VH consultations is well-accepted by families. At BCCH the VH visits are continuing to the present day however in future, VH consultations will need to be made more user friendly to ensure all families can access this type of visit.

Miller, A.,1 Andrews, P.,2 Tenenbaum, H.,3 Basrani, B.,4 Lawrence, H.1

Department of Pediatric Dentistry

University of Toronto, Faculty of Dentistry

OBJECTIVES: In 1997, Primosch et al and in 2005, Dunston and Coll reported disagreement among both dentists and dental educators regarding primary tooth pulp therapy. Neither study included the use of MTA or biosilicates. The present study will provide an update regarding trends in teaching and practice of vital and non-vital pulp therapy in primary molars with deep carious lesions.

METHODS: A Redcap internet survey, was sent to pediatric program directors and a second for pediatric dentists currently in clinical practice. The surveys were designed as modified versions of those published by Primosch in 1997. Three follow-up requests were sent to 6700 pediatric dentists and 89 program directors in Canada and the United States. Results were summarized and analyzed using chi-square tests to allow for comparison to previous studies.

RESULTS: 841 pediatric dentists and 19 program directors completed surveys. Among dentists graduating after 2010, 76.5% reported performing an indirect pulp cap for an imminent pulp exposure, 23.5% reported performing a pulpotomy. Graduates from 2000-2009 selected indirect pulp cap and pulpotomy 49% and 51% respectively, and those graduating from 1960-1999, 56.6% and 43.4% respectively. The most popular pulpotomy medicament among pediatric dentists is MTA (39.2%) followed by formocresol (34.4%). 62% of pediatric dentists reported a change in their pulpotomy medicament since graduation, and 69.9% of those currently using MTA report having used it for 5 years or less. The most commonly taught pulpotomy medicament in training programs is MTA (56.3%) followed by formocresol (12.5%). While 95% of program directors teach pulpectomy, only 55% of practitioners perform the procedure in clinical practice. In a situation during a pulpotomy procedure in which radicular pulp is hemorrhagic and hemostasis is not achieved, dentists report initiating pulpectomy was 36% of 1960-1999 graduates, 31.5% of 2000-2009 graduates, and 22% of graduates 2010-present. In the same clinical situation, the proportion of dentists who reported extraction and appropriate space maintenance was 26.4% of 1960-1999 graduates, 37.8% of 2000-2009 graduates, and 52.7% of graduates 2010-present.

CONCLUSION: There is a shift towards minimally invasive approaches among pediatric dentists for pulp therapy in primary teeth. MTA has marginally overtaken formocresol as the most popular pulpotomy medicament. Although pulpectomy and primary tooth root canal are being taught in training programs, a declining number of dentists perform the procedures in clinical practice, with an increasing number of clinicians opting for extraction and space maintenance for teeth with necrotic or irreversibly inflamed pulps.